Treatment of patients with poor risk non-seminomatous germ cell tumors at advanced stages

Modern chemotherapy followed by surgery can cure the majority of patients with advanced nonseminomatous germ cell tumors but only half of patients with poor risk according IGCCCG classification. The most challenge is to treat frail patients with highly extensive disease. First cycle of induction chemotherapy associates with high complication rate (severe infections, cytopenia, tumor-lysis syndrome, bleedings, respiratory insufficiency) and mortality. Using of low-dose first cycle (2-3 days of EP regimen) instead of full-dose one can improve poor patient»s status, prevent severe toxicity, allow to start next cycle earlier and does not diminish long-term outcome.